Provider Demographics
NPI:1376137984
Name:JACKSON HOSPITAL & CLINIC, INC.
Entity Type:Organization
Organization Name:JACKSON HOSPITAL & CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-293-8820
Mailing Address - Street 1:1842 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066
Mailing Address - Country:US
Mailing Address - Phone:334-293-6899
Mailing Address - Fax:
Practice Address - Street 1:1842 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066
Practice Address - Country:US
Practice Address - Phone:334-293-6899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON HOSPITAL & CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy